160th soar(Abn) Officer Application



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APPLICATION SUMMARY




BIOGRAPHICAL INFORMATION

LAST NAME:

     

FIRST NAME:

     

MIDDLE NAME:

     

RANK / DOR / YG:

     

SSN:

     

SEX:

     

BIRTHPLACE:

     

DOB (MM/DD/YY):

     

AGE:

  

HOME ADDRESS:

     

CITY:

     

STATE / ZIP:

     

UNIT :

     

CITY:

     

STATE / ZIP:

     

HOME PHONE:

     

CELL PHONE:

     

WORK PHONE:

     

WORK EMAIL:

     

PERSONAL EMAIL:

     




MILITARY / AVIATOR QUALIFICATION(S)

PMOS:

     

FLIGHT TIME

SMOS:

     

TOTAL CIVILIAN FLIGHT TIME:

     

ADDITIONAL SKILL IDENTIFIER(S):

     

TOTAL MILITARY FLIGHT TIME:

     

PRIMARY AIRCRAFT / UAS:

     

UAS (AC/AO/PO) TOTAL TIME:

     

OTHER AIRCRAFT / UAS QUAL(S):

     

PC:

     

NVG:

     




     

IP / SP / IE:

     

NS:

     

AIRCRAFT RATINGS:

     

MP / ME:

     

COMBAT:

     


FLIGHT SCHOOL AVIATORS ONLY: Within top 10% Class Standing Former SOF Soldier
QUALIFICATIONS (Check all that apply)
PC IP SP IE MP ME UT XP

AC (UAS) AO (UAS) PO (UAS)
AMCO ASO TACOPS ALSE
SERE-C A/R DLQ Dunker/HEEDS
SFQL Ranger Airborne Jumpmaster Military Free Fall
Air Assault Pathfinder Rigger Combat Diver Jungle Expert

Other:      





ASSIGNMENT PREFERENCE Aircraft Preference (Aviators only)

Please rank in order 1-4 Please rank in order 1-4




A/MH-6 (only at Ft Campbell)



MH-60



MH-47



Needs of the REGT





FTCKY



HAAF



JBLM



Needs of the REGT



*NOTE: UAS only located @ Ft Campbell, KY
Request a Conditional Assessment for a Warrant Officer Aviator Position (AV Commissioned Officers Only requesting reversion from Commissioned to Warrant Officer pending a favorable assessment and HRC approval) Yes No
Additional Preference Request/Remarks:      

APPLICATION SUMMARY (CONTINUED)
What was your report date to current Assignment (MM/YY)?      
Are you currently on orders? Yes No If ‘YES’, next Duty Station       Report Date (MM/YY):      
Are you currently Deployed? Yes No If ‘YES’, Redeployment Date (MM/YY):      
Are you scheduled to Deploy? Yes No If ‘YES’, when (MM/YY):       Redeployment Date (MM/YY):      

How did you learn about the 160TH SOAR(Abn)?


Email Contact Telephone Request Visited Recruiting Office
Former Night Stalker Current Night Stalker Newspaper or Magazine Ad
WOAC or AVCCC Brief I am a Former Special Operations Soldier Other:      
Recruiting Team Brief (Location):      
Have you previously applied to the 160TH? Yes No If ‘YES’, what year? (YYYY)     
Have you previously assessed for the 160TH? Yes No If ‘YES’, what year? (YYYY)     

Are you willing and able to attend Airborne School? Yes No Currently Qualified


Are you willing and able to attend SERE School? Yes No Currently Qualified
Are you willing and able to attend Dunker Training? Yes No Currently Qualified
Have you ever applied to or been assessed by any other organization? If so, what were the dates and outcomes?

     



STATEMENT OF UNDERSTANDING

(Type initials at the end of each statement)
I have read the Pre-Requisites for the application to the 160TH and certify that to the best of my knowledge I am qualified for selection to the organization.      
I understand that I will be assessing for the needs of the 160TH with regard to duty location and aircraft, which will be determined pending a favorable assessment.      

I understand that if accepted for assessment, I will be required to pass the Night Stalker swim test.      



I understand that if accepted for assessment, I will be required to pass a standard Army Physical Fitness Test.      





MILITARY EDUCATION AND TRAINING
List all military courses which you have attended, including those currently in progress. Begin with the most recent.


DATE (YYYY)

COURSE

QUALIFICATION

    

     

     

    

     

     

    

     

     


CIVILIAN EDUCATION
Detail your civilian education (i.e., high school, college, technical/vocational schools) including those currently in progress. Begin with the most recent.


DATE (YYYY)

COURSE / PROGRAM

SCHOOL NAME

QUALIFICATION / GPA

    

     

     

     

    

     

     

     

    

     

     

     


FOREIGN LANGUAGES
Detail any languages other than English and levels of proficiency using the Army rating system.


LANGUAGE

SPEAK / RATING

READ / RATING

WRITE / RATING

     

     

     

     

     

     

     

     

What is your GT Score?    


My High School record was…. Good Average Poor High School GPA:      
My College record was…. Good Average Poor College GPA:      
What were your best subjects?

     

What were your worst subjects?



     

List any scholarships, honors, or fellowships you have received.



     

List all of your extracurricular activities and achievements.



     

List all sports in which you participated in.



     

Were you ever a team captain? Yes No


If ‘YES’, which sports?

     

Were you ever placed on probation, suspended or dropped from a school or college for academic, disciplinary or other reasons?


Yes No
If ‘YES’, provide a short explanation

     

What do you consider your biggest strength? What do you consider your biggest weakness?



     

What characteristics do you most like to see in others?



     



MILITARY WORK EXPERIENCE
In chronological order, list the duties that you have performed in the military. Begin with the most recent. Give a brief description of your duties. The organization understands what a platoon leader does. Do not use your duty description from your OER.


DATES

RANK

UNIT

DUTIES

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     


AIRCRAFT MISHAP
Have you ever been in an aircraft mishap while performing crew duties? Yes No
If ‘YES, explain. Include dates, class of accident and your duty at the time. Do not include precautionary landings. If you require more space, create a Word Document and e-mail it to the recruiter handling your file.

     


CIVILIAN WORK EXPERIENCE
In chronological order, list each civilian job that you have held. Include off-duty employment during military service. Begin with the most recent. If you require more space, create a Word Document with the additional information and e-mail it to the recruiter handling your file.


DATES

EMPLOYER

TYPE OF WORK

REASON FOR LEAVING

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     



MEDICAL BACKGROUND
Are you currently on physical profile? Yes No

If ‘YES, explain your limitations and condition.



     

How would you compare your health with others of the same age and sex?



     

Date of last physical.       Type of last physical?      


List in chronological order with approximate ages, all illnesses, injuries and surgeries that you have had. Include combat wounds and chronic medical conditions. Outcome should be a concise roll up, i.e. full recovery, permanent profile, loss of mobility in leg, etc. Begin with most recent. If you require more space, create a Word Document with the additional information and e-mail it to the recruiter handling your file.


AGE

ILLNESS, INJURIES, and SURGERIES

OUTCOME

  

     

     

  

     

     

  

     

     

  

     

     

List any other medical conditions that you may have.



     

Are you currently taking any medications? Yes No


If ‘YES, list them below:

TYPE / NAME

DATE STARTED

REASON

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     



FAMILY MEDICAL ISSUES
Are any of your family members on the Exceptional Family Member Program (EFMP)? Yes No
If ‘YES, provide a short explanation.

     

Aside from what you have already listed, do any of your family members have limitations or needs (medical, educational or social) which may affect your ability to participate in lengthy or unexpected temporary duty away from home?


Yes No
If ‘YES’, provide a short explanation.

     



LEGAL BACKGROUND
Arrest/UCMJ

Have you ever been suspected of a felony offense, charged with a felony offense, arrested, received an Article 15, had court-martial charges preferred against you, or received a letter of reprimand or other adverse administrative action?


YES NO
If ‘YES’, explain and begin with most recent.

DATE

LEGAL ACTION

REASON

     

     

     

     

     

     


Drugs

Do you now or have you ever used any habit forming drugs such as narcotics or barbiturates, marijuana, crack or cocaine, etc?


YES NO
If ‘YES’, explain below. Include: Type, Frequency, Dates of First and Last Use

     


Alcohol

As a result of consuming alcohol, have you ever been arrested, lost your job, publicly disgraced yourself, damaged your health, or embarrassed or hurt your family? YES NO


If ‘YES’, provide a short explanation.

DATE

CIRCUMSTANCE

OUTCOME

     

     

     

     

     

     


Court Actions

Have you ever brought suit or been sued in a court of law? YES NO


If ‘YES’, list any civil court actions including divorces, final and pending.

DATE

CIRCUMSTANCE

OUTCOME

     

     

     

     

     

     



FINANCIAL STATEMENT
Housing (Current)
GOVT Quarters Purchasing (conventional home) Purchasing (manufactured home) Renting
Other:      
What is your monthly payment?       If you are purchasing a home, what is the remaining balance?      
Do you own any additional properties? YES NO
If ‘YES’, provide data.

PROPERTY DESCRIPTION

MONTHLY PAYMENT

BALANCE OWED

     

     

     

     

     

     


General





MONTHLY AMOUNT

Utilities (Cell and Home Phone, Gas, Electricity, Water, Trash, Internet, etc.)

     

Food

     

Medical

     

Insurance

     

Entertainment

     



Vehicles
Include all cars, motorcycles, boats, jet-skis, etc.

YEAR

MAKE

MODEL

MONTHLY PAYMENT

BALANCE OWED

    

     

     

     

     

    

     

     

     

     

    

     

     

     

     


Credit Cards
List all credit cards that you have. Do NOT include card numbers.

TYPE OF CARD

MONTHLY PAYMENT

BALANCE OWED

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     



Other Loans
List any other loans that you have.

TYPE OF LOAN

MONTHLY AMOUNT

BALANCE OWED

     

     

     

     

     

     


Additional Expenses
List any additional expenses or obligations that you have.

NAME OF EXPENSE

MONTHLY PAYMENT

BALANCE OWED (IF APPLICABLE)

     

     

     

     

     

     


Total Monthly Expenses


MONTHLY TOTAL

TOTAL REMAINING BALANCES

     

     


Income





MONTHLY INCOME

Base Pay

     

Additional Military Entitlements

     

Spouse’s Income

     

Other Income (for annual bonus divide total by 12)

     

Total Monthly Income

     


Bankruptcy
Have you ever declared bankruptcy? YES NO
If ‘YES’, explain.

     

Are you under any financial strain or hardship that could pose a problem if you are assigned to this unit? YES NO


If ‘YES’, explain.

     

Have you ever had financial problems, late payments, excessive debt, etc? YES NO


If ‘YES’, explain.

     



GENERAL INFORMATION
Foreign Travel
List your foreign travel including military assignments.

COUNTRIES

DATES

REASON

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

List any members of your immediate family that resides overseas.



RELATIONSHIP

AGE

COUNTRY LIVING IN

CITIZENSHIP

     

   

     

     

     

   

     

     

     

   

     

     

     

   

     

     


Additional Information
Do you and your spouse participate in your unit’s family readiness group (FRG)? Give a short description of why or why not.

     

Are your dependents capable of caring for their own needs in your absence? YES NO


If no, explain.

     

Why do you want to be assigned to this unit?



     

What jobs do you want in this unit?



     

If you are successful in your selection, how long do you want to be assigned to this unit?



     



Qualities: Rate yourself on the qualities listed below.





WEAK STRONG

1

2

3

4

5

Agility











Speed











Moral Courage











Endurance











Physical Strength












Traits: Numerically rank the following 14 traits from your strongest (1) to your weakest (14).
Use every number and use one number for each space (pull-down numbers).

Integrity



Courage



Reliability



Confidence



Initiative



Decisiveness



Discipline



Professionalism



Adaptability



Team Player



Perseverance



Humility



Judgement



Loyalty





Which is your strongest trait and provide a short explanation?



     

Which is your weakest trait and provide a short explanation?



     

No matter how careful we are, we all have embarrassing moments. Please describe your most embarrassing moment or experience.



     

Describe a success you’ve experienced during your military career (on or off duty)?



     

Describe a failure you’ve experienced during your military career (on or off duty)?



     

What things or situations are you most afraid of?



     

What behavior or characteristics do you most dislike to see in other people?



     

What characteristics do you most dislike about yourself?



     



LETTERS OF REFERENCE (LOR)
References ARE required. A solid reference can greatly enhance the strength of your application. Of course, by implication a bad reference can adversely impact your chances for assessment.
Please include all pertinent information.
If an individual is in the armed services please list the appropriate rank.


LOR #1: BN COMMANDER

LOR #2: COMPANY COMMANDER

NAME:

     

NAME:

     

RANK:

     

RANK:

     

UNIT:

     

UNIT:

     

POST:

     

POST:

     

PHONE:

     

PHONE:

     

E-MAIL:

     

E-MAIL:

     

*Flight School applicants: Leave LOR#1 (BN CDR) block blank*


LOR #3: Instructor Pilot (Aviator only) / Co-Worker

LOR #4: Friend or Co-Worker

NAME:

     

NAME:

     

RANK:

     

RANK:

     

UNIT:

     

UNIT:

     

POST:

     

POST:

     

PHONE:

     

PHONE:

     

E-MAIL:

     

E-MAIL:

     

RELATIONSHIP:

     

RELATIONSHIP:

     




LOR #5: Friend or Co-Worker

NAME:

     

RANK:

     

UNIT:

     

POST:

     

PHONE:

     

E-MAIL:

     

RELATIONSHIP:

     



OFFICIAL FORM INSTRUCTIONS
The next 5 documents are official consent forms. Carefully read each one. By placing your name or initials and dating the document you are certifying that you accept the terms that are stated on each. This is no way obligates you to the 160TH SOAR(Abn), it merely allows the organization to perform a full review and assessment of you. Print off the Security Clearance Verification Sheet and have it signed by your S2 and send it in to your recruiter handling your packet.

VOLUNTEER STATEMENT
I. GENERAL
As a staff officer, you can expect to assist in the planning, coordination and implementation of special operations aviation missions. As an operational pilot, crew-member, and UAS Operator/Technician, you will be exposed to the most demanding duty of your military career. As a volunteer, you will be expected to expend every effort in fulfilling mission requirements that are vital to the national defense. You will receive little recognition for your efforts due to the inherent secrecy and sensitivity of your training and real-world mission contingencies. You are sworn, under threat of breach of national security, to remain silent pertaining to all contingency training and operations (a separate security statement will be executed). After certifying volunteer status you may be evaluated by the Special Operations Aviation Training Battalion (SOATB) to determine your individual capabilities and compatibility for known unit contingencies. If accepted you can expect assignment to the 160TH SOAR(Abn) for a normal tour of duty. If you request curtailment of this voluntary assignment you will be reassigned based upon the needs of the Army and your individual qualifications. Reassignment will be effected immediately upon termination of volunteer status. Upon successful completion of your assignment, the experience which you have gained will warrant individual tracking of your career. Continued assignment or reassignment to a similar unit is probable based upon your desires, the Regiment Commander's recommendation and the needs of the Army. An extension of your tour may be possible upon request. You must understand that duty with the 160TH SOAR(Abn) does not guarantee an increased opportunity for promotion, desirable assignments or other perceived rewards. You will have the personal satisfaction of being a member of an elite team that trains for success.
II. EXECUTION
By order of the Office of the Deputy Chief of Staff for Operations and Plans, Headquarters, Department of the Army, those personnel occupying key staff or operational positions with designated elements must be volunteers. In recognition of this fact and having read and understood the information above.


I,

     

, hereby volunteer for duty with the 160TH SOAR(Abn).

Volunteer’s Initials:      Rank:       Date:      









DEPARTMENT OF THE ARMY

160TH SPECIAL OPERATIONS AVIATION REGIMENT (AIRBORNE)

7277 NIGHT STALKER WAY

FORT CAMPBELL, KENTUCKY 42223-6012

1


AOAV-SA

MEMORANDUM FOR COMMANDER, 160TH SOAR(Abn)


SUBJECT: Active Duty Service Obligation (ADSO)

I understand that assignment to the l60TH SOAR(Abn) for training in the AH/MH-6, MH-60, MH-47, and MQ-1C will result in an ADSO of four years. I also understand the ADSO will go into effect upon completion or termination of this training. I understand that the ADSO is to the U.S. Army and not the 160TH SOAR(Abn).

Full Name:       Date:      

PRIVACY ACT STATEMENT

1. AUTHORITY: 5, U.S.C. Sec. 301; 10 U.S.C. SEC.3012
2. PURPOSE: The Officer Application serves as an integral source of information for assignment consideration to the 160th SOAR(Abn).
3. ROUTINE USES: The Officer Application is used to screen potential candidates for assignment to the 160TH SOAR(Abn). All information you provide may be disclosed only to members of the 160TH SOAR(Abn) who have a need for the information in the performance of their official duties.
4. DISCLOSURE: Disclosure of information in the Officer Application is voluntary. Failure to provide all information requested may hinder favorable consideration of the application for assignment.

Full Name:       Date:      










DEPARTMENT OF THE ARMY

160TH SPECIAL OPERATIONS AVIATION REGIMENT (AIRBORNE)

7277 NIGHT STALKER WAY

FORT CAMPBELL, KENTUCKY 42223-6012

2


AOAV-SA

MEMORANDUM FOR COMMANDER, 160TH SOAR(Abn)


SUBJECT: Voluntary Consent to Psychological Assessment

1. I hereby request and volunteer to participate in cognitive, physical, psychomotor and personality assessments as a part of the selection process for assignment to the 160TH SOAR(Abn). I understand that all psychological assessments will be accomplished under the direction of the 160TH Psychologist. I further understand that information obtained from these assessments will be used for two purposes: one, to aid the selection board in a determination of my suitability to serve as a member of the unit, and two, to aid in compiling an anonymous database for future studies. No other use of the information obtained from these psychological assessments will be made without my prior consent.


2. I understand that since my psychological assessment is an employment screen, I will not be provided a debrief during this assessment selection process. I understand that if there are findings which should be brought to my attention, the Regimental Psychologist will provide me appropriate feedback.
3. I understand that, at any time, I may withdraw my consent to participate in the assessment, thereby removing myself from consideration for assignment to the unit. I further understand that my non-consent or withdrawal of consent, to participate in the assessments will create no adverse effect on my career or otherwise incur any penalty.

Full Name:       Date:      










DEPARTMENT OF THE ARMY

160TH SPECIAL OPERATIONS AVIATION REGIMENT (AIRBORNE)

7277 NIGHT STALKER WAY

FORT CAMPBELL, KENTUCKY 42223-6012

3


AOAV-SA

MEMORANDUM FOR RECORD


SUBJECT: Security Clearance Verification

1. APPLICANT: Complete SECTION I and hand carry this form to your Security Manager so that it may be properly verified.


2. SECURITY MANAGER: Please complete SECTION II so that we may verify this individual's level of clearance.

SECTION I


LAST NAME

FIRST NAME

MI

RANK

SSN

     

     

   

     

     




DATE OF BIRTH (MM/DD/YY)

PLACE OF BIRTH

CITIZENSHIP

     

     

     



SECTION II


CLEARANCE

DATE GRANTED

(MM/DD/YY)

TYPE INVESTIGATION

DATE COMPLETED

(MM/DD/YY)

     

     

     

     




VERIFYING OFFICIAL

NAME:

     

RANK:

     

FULL UNIT ID and LOCATION:

     

SIGNATURE:

     

3. POC is 160TH SOAR(Abn), DSN 635‑4384/5689 or commercial (502)798‑9819.










DEPARTMENT OF THE ARMY

160TH SPECIAL OPERATIONS AVIATION REGIMENT (AIRBORNE)

7277 NIGHT STALKER WAY

FORT CAMPBELL, KENTUCKY 42223-6012

4


AOAV-SA

MEMORANDUM FOR RECORD


SUBJECT: Voluntary Polygraph Examination

1. As a requirement for consideration of assignment to the 160TH SOAR(Abn), I voluntarily consent to submit to polygraph examinations as deemed necessary by the Commander, 160th SOAR(Abn).


2. I further understand that refusal to submit to polygraph examinations will prevent favorable consideration of my request for assignment to, or continued retention in, the 160TH SOAR(Abn). I certify that this is a voluntary statement, executed willfully, without coercion.

Full Name:       Date:      


AOAV-SA

MEMORANDUM FOR RECORD


SUBJECT: Voluntary Social Media Examination
1. As a requirement for consideration of assignment to the 160th SOAR(Abn), I voluntarily consent to a social media review on public websites. The review will consist of an internet search of public social media websites using email addresses and/or usernames; under no circumstance will I provide my personal password(s) for complete access to my social media websites.
2. I understand that information obtained from these searches will be used to aid the selection board in a determination of my suitability to serve as a member of the unit. No other use of the information obtained from these searches will be made without my prior consent.
3. I further understand that refusal to submit usernames and email addresses for a search of social media use may prevent favorable consideration of my request for assignment to the 160th SOAR(Abn). I certify that this is a voluntary statement, executed willfully, without coercion.

Full Name:       Date:      




You have submitted an application, what happens next?
Thank you for your interest in our organization. The following is provided as guidance for understanding the application process:
1. You have received a 160TH SOAR(Abn) application packet. The application is self-explanatory. However, if you have questions please feel free to contact the recruiting office for assistance. Once you have completed the application it is beneficial to you and to our organization to submit your supporting documentation in a timely manner.
2. The character references that you listed are mailed a questionnaire within 24 hours of receipt of your application. The questionnaire is digital to aid the individual in returning the questionnaire as quickly as possible. It is recommended that you contact each one personally. Inform them that they will be receiving a questionnaire. In the same time frame as the references, we may request a Manner of Performance (MOP) from the Special Management Division at DA informing us on how you rank amongst your peers.
3. When the packet is complete and ready for review, it is transferred to the Assessment Office. Upon receipt of your packet, the Assessment Office will provide you with an update and contact information. The review process takes an average 2-3 months to complete. Communication with the Assessment Office should be limited to providing your status and document updates (Orders, OER’s, DA 705/759, ORB, etc..)
4. Once the application has completed the review process, the Assessment Officer will contact you with one of three possible results: (1) Approved for Assessment (2) Not Approved for Assessment – Reapply (3) Not Approved for Assessment – Do not Reapply

If your application is approved for an assessment, you will be provided a list of Assessment dates to select from. If your application is disapproved for an assessment, a letter will be sent to you with an explanation.


5. In the event an assessment is scheduled, instructions are provided via a letter of instruction.

Again, thank you for your interest with the 160TH SOAR(Abn). We are looking forward to receiving your application. If you have any questions, contact our office (270) 798-9819 or DSN 635-9819.






CW4 Robert L. Minton

Regimental Recruiting Officer




FOR OFFICIAL USE ONLY

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